Abstract
Sixteen patients (13–38 yr) undergoing spinal fusion for scoliosis under controlled hypotension were studied to determine the haemodynamic and neuroendocrine responses to TV dihydralazine (1.0 mg · kg-1) followed by 0.5 and 1 MAC of enflurane or isoflurane. Twenty minutes after dihydralazine administration mean arterial pressure (-20 per cent) and systemic vascular resistance (-50 per cent) decreased, and cardiac index (+57 per cent), heart rate (+37 per cent) and intrapulmonary shunt increased. Plasma renin activity and aldosterone and norepinephrine levels increased. Further decreases in mean arterial pressure and in systemic vascular resistance were observed when 0 .5 MAC enflurane or isoflurane were added. With 1 MAC anaesthetic levels a further decrease in mean arterial pressure was observed in both goups, but pressure fell to a lower level with isoflurane than with enflurane (p < 0.01). The reduction of arterial blood pressure to a level of 50–60 mmHg for three to four hours was easy to control and was free of complications. The preliminary PV administration of dihydralazine allowed a reduced volatile agent concentration which attenuated undesirable haemodynamic effects, in spite of renin and norepinephrine release, and permitted a rapid intraoperative awakening.
Résumé
La réponse hémodynamique et neuroendocrinienne à ľinjection intraveineuse de dihydralazine (1.0 mg · kg-1) suivie de ľadministration ďenflurane ou ďisoflurane (0.5 puis 1.0 MAC) a été étudiée chez 16 patients âgés de 13 à 38 ans subissant une correction chirurgicale de scoliose sous hypotension contrôlée. Vingt minutes après ľinjection de dihydralazine, la pression artérielle moyenne et les résistances vasculaires systémiques se sont abaissées (-20 et -50 pour cent respectivement) et ľindex cardiaque et la fréquence cardiaque se sont élevés (+57 et +37 pour cent respectivement) de même que le shunt intrapulmonaire. Une diminution supplémentaire de la pression artérielle moyenne et des résistances vasculaires systémiques a été observée après introduction ďenflurane ou ďisoflurane à MAC 0.5. ľaugmentation de la concentration alvéolaire à MAC 1.0 a majoré la baisse de pression artérielle dans les deux groupes, mais le niveau de pression atteint a été plus bas avec ľisoflurane qu’avec ľenflurane (p < 0.01). La réduction de pression artérielle moyenne à un niveau de 50 à 60 mmHg a été facile à contrôler pendant trois à quatre heures et n’a pas entraîné de complication. ľadministration intraveineuse préalable de dihydralazine permet la réduction des concentrations alvéolaires des agents anesthésiques volatils ce qui atténue leurs effets hémodynamiques indésirables en dépit ďune libération de rénine et de noradrénaline, et donc facilite un réveil peropératoire rapide.
Article PDF
Similar content being viewed by others
References
Khambatta HJ, Stone JG, Matteo RB, Michelsen WJ. Hypotensive anesthesia for spinal fusion with sodium nitroprusside. Spine 1978; 3: 171–6.
Kafer ER. Respiratory and cardiovascular functions in scoliosis and the principles of anesthetic management. Anesthesiology 1980; 52; 339–51.
Malcolm-Smith NA, McMaster MJ. The use of induced hypotension to control bleeding during posterior fusion for scoliosis. J. Bone Joint Surg (Br) 1983; 65: 255–8.
Lam AM. Induced hypotension. Can Anaesth Soc J 1984; 31: S56-S62.
James DJ, Bedford RF. Hydralazine for controlled hypotension during neurosurgical operations. Anesth Analg 1982; 61: 1016–9.
Black GW. Enflurane. Br J Anaesth 1979; 51: 627–37.
Abott TR, Bentley G. Intraoperative awakening during scoliosis surgery. Anaesthesia 1980; 35: 289–302.
Dorgan JC, Abott TR, Bentley G. Intraoperative awakening to monitor spinal cord function during scoliosis surgery. J Bone Joint Surg (Br) 1984; 66: 716–9.
Eger EI II. The pharmacology of isoflurane. Br J Anaesth 1984; 56: 71S-99S.
Hug CC Jr. Monitoring.In: Miller RD (Ed.). Anesthesia Second Edition. New York: Churchill Livingstone Inc. 1986; 411–63.
Haber E, Koerner T, Page LB, Kimura B, Purnode A. Application of radioimmunoassay for angiotensin I to the physiologic measurements of plasma renin activity in normal human subjects. J Clin Endocrinol 1969; 29: 1349–55.
Mayes D, Furuyama S, Kem DC, Nugent CA. Radioimmunoassay for plasma aldosterone. J Clin Endocrinol 1970; 30: 682–5.
Brown MJ, Jenner DA. Novel double-isotope technique for enzymatic assay of catecholamines, permitting high precision, sensitivity and plasma sample capacity. Clin Sci 1981; 61: 591–8.
Trunet P, Lhoste F, Ansquer JC et al. Decreased plasma epinephrine concentrations after glucose ingestion in humans. Metabolism 1984; 33: 101–3.
Struyker-Boudier HAJ, Van Essen H,Smits JFM. Hemodynamic effects of the arteriolar vasodilator hydralazine, dihydralazine and endralazine in the conscious spontaneously hypertensive rat. Eur J Pharmacol 1983; 95: 151–9.
Koch-Weser J. Hydralazine. N Engl J Med 1976; 295: 320–3.
Khatri I, Vemura O, Notargiacomo A, Freis ED. Direct and reflex cardiostimulating effects of hydralazine. Am J Cardiol 1977; 40: 38–42.
Zacest R, Koch-Weser J. Relation of hydralazine plasma concentrations to dosage and hypotensive action. Clin Pharmacol Ther 1972; 13: 420–5.
Ludden TM, Shepherd AM, McNay JL, Lin MS. Effects of intravenous dose on hydralazine kinetics after administration. Clin Pharmacol Ther 1983; 34: 148–52.
Gerson JI, Allen FB, Seltzer JL, Parker FB, Markowitz AH. Arterial and venous dilatation by nitroprusside and nitroglycerin. Is there a difference? Anesth Analg 1982; 61: 256–60.
Brent BN, Berger HJ, Matthay RA, Mahler D, Pytlik L, Zaret BL. Contrasting acute effects of vasodilators (nitroglycerin, nitroprusside, and hydralazine) on right ventricular performance in patients with chronic obstructive pulmonary disease and pulmonary hypertension: A combined radionuclide-hemodynamic study. Am J Cardiol 1983; 51: 1682–9.
Cohn JN, Franciosa JA. Vasodilator therapy of cardiac failure (first of two parts). N Engl J Med 1977; 297: 27–31.
Stern HC, Matthews HJ, Belz GG. Influence of dihydrala-zine induced afterload reduction on systolic time intervals and echocardiographic in healthy subjects. Br Heart J 1984; 52: 435–9.
Magorien RD, Brown GP, Underferth DV et al. Effects of hydralazine on coronary blood flow and myocardial energetics in congestion heart failure. Circulation 1982; 65: 528–33.
Casthely PA, Lear S, Cottrell JE, Lear E. Intrapulmonary shunting during induced hypotension. Anesth Analg 1982; 61: 231–5.
Sandoval J, Lopez R, Beltran U et al. Effect of hydralazine on intrapulmonary shunt. Crit Care Med 1986; 14: 689–92.
Pettinger WA Campbell WB, Keeton K. Adrenergic component of renin release induced by vasodilating antihypertensive drugs in the rat. Cir Res 1973; 33: 82–6.
Peach MJ. Renin-angiotensin system: biochemistry and mechanisms of action. Physiol Rev 1977; 57: 313–70.
Pettinger WA. Anesthetics and the renin-angiotensin-aldosterone axis. Anesthesiology 1978; 48: 393–6.
Lin MS, McNay JL, Shepherd AM, Keeton TK. Effects of hydralazine and nitroprusside on plasma catecholamines and heart rate. Clin Pharmacol Ther 1983; 34: 474–80.
Jones RM. Clinical comparison of inhalation anaesthetic agents. Br J Anaesth 1984; 56: 57S-69S.
Korttila K, Valanne J. Recovery after outpatient isoflurane and enflurane anesthesia. Anesth Analg 1985; 64: 239.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bourreli, B., Pinaud, M., Passuti, N. et al. Additive effects of dihydralazine during enflurane or isoflurane hypotensive anaesthesia for spinal fusion. Can J Anaesth 35, 242–248 (1988). https://doi.org/10.1007/BF03010617
Issue date:
DOI: https://doi.org/10.1007/BF03010617
